Postmenopausal women can suffer significant bone density loss in their hip after being treated with a single epidural steroid injection for back pain, according to a new study at Henry Ford Hospital in Detroit.
Researchers say bone density loss after six months was six times greater for women who had an epidural than for woman who didn’t receive a steroid injection.
“The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility,” said Shlomo Mandel, MD, a Henry Ford orthopedic physician and lead author of the study, which is being published in the journal Spine.
In the observational study, Mandel and his colleagues evaluated 28 postmenopausal women, aged 65 and older, who were treated with an epidural steroid injection (ESI) for lumbar stenosis, an abnormal narrowing of the spine canal. Their bone mineral density (BMD) was measured before receiving the injection, and at three and six-month intervals.
“A single ESI in postmenopausal women adversely affects BMD of the hip,” said Mandel. “Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy.”
Postmenopausal woman are at risk of developing osteoporosis because their production of estrogen drops off dramatically, making their bones more brittle and likely to fracture. Estrogen helps maintain healthy levels of calcium and other bone minerals.
Mandel says steroid injections should be used with caution for women at risk of bone fractures. Physicians who prescribe epidurals, he adds, should consider other measures to strengthen their patients’ bones, such as calcium, vitamin D supplements and exercise.
“Patients receiving multiple steroid injections with a history of steroid exposure may be especially susceptible to compromised bone strength,” Mandel said.
In October, Mandel presented a similar study at the annual meeting of the North American Spine Society. It found that epidural steroid injections for back pain increased the risk of bone fractures. Each steroid injection raised the risk of a spinal fracture by 29 percent, according to the study.